Healthcare Provider Details

I. General information

NPI: 1124072723
Provider Name (Legal Business Name): LYNDA CATHERINE HAMMOND MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 WILDWOOD AVE SUITE B
JACKSON MI
49201-1044
US

IV. Provider business mailing address

517 WILDWOOD AVE SUITE B
JACKSON MI
49201-1044
US

V. Phone/Fax

Practice location:
  • Phone: 517-782-1500
  • Fax: 517-782-1308
Mailing address:
  • Phone: 517-782-1500
  • Fax: 517-782-1308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number4301065180
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: